The sonographer's use of spectral Doppler in the common femoral vein for the assessment of iliac vein obstructions: A retrospective audit

Abstract

AbstractIntroductionIliac vein obstructions account for 2%–3% of all lower limb deep vein thromboses (DVT). Delayed diagnosis can lead to a higher risk of limb ischemia in the acute setting and post‐thrombotic syndrome in the chronic setting. The purpose of this audit was to determine whether sonographers were taking and interpreting waveforms correctly at the common femoral vein (CFV).MethodsA retrospective audit was performed of all the DVT patients (n = 375) over the course of 3 months. Changes in phasicity during Valsalva, respiration or augmentation of the spectral waveform at the CFV was recorded.ResultsWithin the cohort group of 375 examinations assessed. Only 277 (74%) patients had spectral traces taken at the level of the CFV. 29 (10%) patients had persistent monophasic waveforms that did not change significantly when a Valsalva manoeuvre was performed, eight patients (2%) had confirmed iliofemoral vein obstruction with either ultrasound or computed tomography venogram.ConclusionThe audit results show that spectral traces at the CFV are not always being taken or assessed effectively in clinical practice for various reasons; highlighting a potential clinical risk. With a combination of education, improved department protocols and workflow strategies, the standard of sonography should be improved.